Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty

Moucha, Calin S.; Weiser, Mitchell C.; Levin, Emily J.

doi:10.5435/jaaos-d-14-00259

Cited by 165 publications

(112 citation statements)

References 20 publications

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Section: Multimodal Analgesiamentioning

confidence: 99%

“…The goal has been to improve perioperative pain control while minimizing systemic narcotic consumption 27. This approach reduces the undesired adverse effects of narcotics such as nausea, vomiting, sedation, respiratory depression, and pruritus while increasing participation with physical activity and patient satisfaction 27. Current early recovery protocols often include pre- and postoperative opioid and nonopioid oral analgesics, as well as postoperative regional analgesic techniques in an effort to decrease the use of intravenous opioids while still providing adequate pain relief 27…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…Two of the most commonly used peripheral nerve blocks for pain control after TKA are the femoral nerve block (FNB) and the adductor canal block (ACB) 27. A meta-analysis was conducted to compare FNB/infusion as postoperative analgesia compared to other common analgesia modalities 29.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

“…It results in a blockade of the anteromedial knee at the level of the superior pole of the patella and the medial lower leg 27. A small, double-blind, placebo controlled study was conducted to study the effects of ACB on TKA patients 30.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

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Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Turnbull

Sastow

Giambrone

et al. 2017

LRA

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Total knee arthroplasty (TKA) has become one of the most common orthopedic surgical procedures performed nationally. As the population and surgical techniques for TKAs have evolved over time, so have the anesthesia and analgesia used for these procedures. General anesthesia has been the dominant form of anesthesia utilized for TKA in the past, but regional anesthetic techniques are on the rise. Multiple studies have shown the potential for regional anesthesia to improve patient outcomes, such as a decrease in intraoperative blood loss, length of stay, and patient mortality. Anesthesiologists are also moving toward multimodal analgesia, which includes peripheral nerve blockade, periarticular injection, and preemptive analgesia. The goal of multimodal analgesia is to improve perioperative pain control while minimizing systemic narcotic consumption. With improved postoperative pain management and rapid patient rehabilitation, new clinical pathways have been engineered to fast track patient recovery after orthopedic procedures. The aim of these clinical pathways was to improve quality of care, minimize unnecessary variations in care, and reduce cost by using streamlined procedures and protocols. The future of TKA care will be formalized clinical pathways and tracks to better optimize perioperative algorithms with regard to pain control and perioperative rehabilitation.

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Section: Multimodal Analgesiamentioning

confidence: 99%

Section: Multimodal Analgesiamentioning

confidence: 99%

Section: Multimodal Analgesiamentioning

confidence: 99%

Section: Multimodal Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Turnbull

Sastow

Giambrone

et al. 2017

LRA

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“…Pain following total knee arthroplasty (TKA) can be severe and limit early mobilization and recovery 3 4. Femoral nerve blocks (FNBs) and adductor canal blocks (ACBs) are two of the most commonly performed peripheral nerve blocks (PNBs) as part of non-opioid multimodal analgesia following TKA 5. These approaches target the nerve supply to the anterior knee joint capsule.…”

Section: Introductionmentioning

confidence: 99%

Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention

Tran

Peng

Gofeld

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

102

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Background and objectivesPeripheral nerve block is an important component of the multimodal analgesia for total knee arthroplasty. Novel interventional techniques of ultrasound-guided nerve block supplying the posterior knee joint capsule require knowledge of the innervation of the posterior capsule. The objectives of this cadaveric study were to determine the course, frequency, and distribution of the articular branches innervating the posterior knee joint capsule and their relationships to anatomical landmarks.MethodsFifteen lightly embalmed specimens were meticulously dissected. The origin of articular branches was identified, their frequency recorded, and the course documented in relation to anatomical landmarks. The capsular distribution of articular branches was documented and a frequency map generated.ResultsIn all specimens, articular branches from the posterior division of the obturator and tibial nerves were found to supply the posterior capsule. Additionally, articular branches from common fibular nerve and sciatic nerve were found in eight (53%) and three (20%) specimens, respectively. The capsular distribution of tibial nerve spanned the entire posterior capsule. The posterior division of obturator nerve supplied the superomedial aspect of the posterior capsule overlapping with the tibial nerve. The superolateral aspect of the posterior capsule was innervated by the tibial nerve and, when present, the common fibular/sciatic nerves.ConclusionsFrequency map of the course and distribution of the articular branches and their relationship to anatomical landmarks form an anatomical basis for peripheral nerve block approaches that provide analgesia to the posterior knee joint capsule.

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Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

Lindberg

Miaskowski

Rustøen

et al. 2020

European Journal of Pain

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Background One in five patients experience chronic pain 12 months following total knee arthroplasty (TKA). This longitudinal study used a person‐centred approach to identify subgroups of patients with distinct chronic pain profiles following TKA and identified preoperative characteristics associated with these profiles. Methods On the day before surgery, 202 patients completed questionnaires that assessed pain, interference with functioning, fatigue, anxiety, depression and illness perceptions. Average and worst pain were assessed prior to surgery, on postoperative day 4, at 6 week and at 3 and 12 months following surgery. Using growth mixture modelling, two subgroups with distinct average and worst pain profiles were identified. Results Patients in the “lower average” and “lower worst” pain classes had moderate preoperative pain scores that decreased over the remaining 9 months following TKA. Patients in the “higher average” and “higher worst” pain classes had relatively higher preoperative pain scores that increased during the first three months and then decreased slightly over the remaining 9 months. Patients in the higher pain classes had higher interference with function scores; used opioids prior to surgery more often, were more likely to receive a continuous nerve block and ketamine; had higher preoperative fatigue severity and interference scores; and had worse perceptions of illness than patients in the lower pain classes. Conclusions These risk factors may be used to identify subgroups of patients at higher risk for more severe pain after TKA. Future studies should test whether modifying these risk factors can improve patients’ outcomes after TKA. Significance statement The present study provides a novel and original analysis of pain profiles following total knee arthroplasty that may contribute to our understanding of the transition from acute to chronic pain. Our results may be used to identify patients at higher risk for poorer outcomes based on preoperative risk factors.

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Current Strategies in Anesthesia and Analgesia for Total Knee Arthroplasty

Cited by 165 publications

References 20 publications

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Anesthesia for the patient undergoing total knee replacement: current status and future prospects

Anatomical study of the innervation of posterior knee joint capsule: implication for image-guided intervention

Preoperative risk factors associated with chronic pain profiles following total knee arthroplasty

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